Optimal Sizing of Aortic Stent Graft for Blunt Thoracic Aortic Injury Considering Hypotension-Related Decrease in Aortic Diameter.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-08-01 Epub Date: 2022-11-07 DOI:10.1177/15266028221134894

Miju Bae, Chang Ho Jeon

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引用次数: 0

Abstract

Purpose: To evaluate the optimal sizing of an aortic stent graft in patients with blunt thoracic aortic injury (BTAI), considering the decrease in diameter in hypovolemic status.

Materials and methods: From 2014 to 2020, 25 patients who underwent thoracic endovascular aortic repair (TEVAR) for BTAI were included. Hemodynamic parameters in the emergency room (ER) and just before the main procedure (MP) were collected. The aortic sizes were measured during initial computed tomography (CT) on arrival in the ER, aortography (AG) during TEVAR, and final CT in the outpatient clinic. The appropriateness of the inserted stent graft size was investigated.

Results: The mean values of the final CT/initial CT and final CT/initial AG (proximal descending thoracic aorta [pDTA]) were 113% and 105%, respectively. The final CT/initial CT (pDTA; 122.2% vs 108.8%, p=0.01) and final CT/initial AG (pDTA; 113.4% vs 102.1%, p<0.01) were significantly higher in patients with systolic blood pressure (SBP; MP) ≤90 mm Hg. The final CT/initial CT (pDTA; 120.4% vs 109.0%, p=0.03) and final CT/initial AG (pDTA; 111.4% vs 102.6%, p=0.01) were significantly higher in patients with mean blood pressure (MBP; MP) ≤70 mm Hg. On an average, the inserted stent grafts were oversized by 130% on initial AG. Based on the final CT scan, the inserted stent graft was as large as 122%.

Conclusion: In the case of hemodynamic instability with SBP (MP) ≤90 mm Hg or MBP (MP) ≤70 mm Hg, despite adequate resuscitation, an oversized TEVAR stent graft of 130% can reduce the occurrence of endoleak and is sufficiently safe.

Clinical impact: Despite sufficient resuscitation, the aorta size measured during TEVAR in patients with hemodynamic instability with systolic BP <90 mmHg and mean BP <70 mmHg may be reduced by more than 15% compared to that in the normal state. In this study, the mean size of the stent grafts were oversized by 130% on initial aortography, but were oversized by 122% based on final CT. When the stent graft was oversized by 130% in TEVAR for hemodynamic unstable patient with BTAI, the patient reached the proper oversizing subsequent to hemodynamic recovery.

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考虑到低血压导致的主动脉直径减小，主动脉支架移植治疗钝性胸主动脉损伤的最佳尺寸。

目的：评估钝性胸主动脉损伤（BTAI）患者主动脉支架移植物的最佳尺寸，同时考虑低血容量状态下直径的减小：纳入2014年至2020年期间因BTAI接受胸腔内血管主动脉修复术（TEVAR）的25例患者。收集了急诊室（ER）和主要手术（MP）前的血流动力学参数。在抵达急诊室时的初始计算机断层扫描（CT）、TEVAR期间的主动脉造影（AG）和门诊的最终CT中测量了主动脉尺寸。对插入的支架移植物尺寸是否合适进行了调查：最终 CT/初始 CT 和最终 CT/初始 AG（近端降主动脉 [pDTA]）的平均值分别为 113% 和 105%。最终CT/初始CT（pDTA；122.2% vs 108.8%，p=0.01）和最终CT/初始AG（pDTA；113.4% vs 102.1%，p=0.01）结论：结论：在SBP（MP）≤90 mm Hg或MBP（MP）≤70 mm Hg的血流动力学不稳定情况下，尽管进行了充分的复苏，但130%的超大TEVAR支架移植物可减少内漏的发生，并且足够安全：临床影响：尽管进行了充分的复苏，但在血流动力学不稳定、收缩压

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.